Chronic pain serves no beneficial purpose, but arises from pathological alterations in nociceptive neural networks. Neuropathic pain is a form of chronic pain that arises after nerve injury caused by trauma, infection, or pathology. Neuropathic pain persists long after the initiating event has healed. While neurons are involved in neuropathic pain, they are unlikely to be the sole cell type mediating this condition. There is a growing body of evidence that supports a role for glia-neuron interactions in establishing and maintaining neuropathic pain. Microglia, in particular, have emerged as key players in neuropathic pain. The microglial P2X4 receptor appears to be important in the development and maintenance of neuropathic pain.
The ion channel P2X4 is one of seven members of a family of purinergic, cation permeable channels. Each P2X4 subunit has two transmembrane domains, separated by a large ˜280 amino acid extracellular domain. Functional channels are formed of a trimeric arrangement of subunits with a central pore. The P2X4 channel is activated by binding of the ligand adenosine 5′-triphosphate (ATP) to residues contained within its extracellular domain. Activation of these receptors instigates a series of conformational changes that allow cations, such as Ca2+ and Na+, entry into the cell through a cation selective channel. P2X4 activation and upregulation is thought to be a key driver of neuropathic pain. Downstream of P2X4 activation, microglia release brain derived neurotrophic factor (BDNF), which acts on spinal lamina I neurons to reduce expression of a neuronal chloride transporter KCC2, thereby altering the electrochemical gradient for chloride and rendering one of the main inhibitory neurotransmitters GABA excitatory. Therefore, P2X4-mediated BDNF release in spinal cord is thought to be a key driver of neuropathic pain.
Neuropathic pain fails to respond to currently available analgesics, and is considered to be one of the most debilitating chronic pain conditions. Accordingly, improved methods for treating neuropathic pain, particularly pain mediated by P2X4 are urgently required.